The “Key” or “Critical” Portions of an Operation: Understanding Attending Supervision and Resident Autonomy From a Legal Perspective

Williams, Aaron M.; Chang, Emma; Boothman, Richard C; Thompson-Burdine, Julie A.; Minter, Rebecca M.; Sandhu, Gurjit

doi:10.1016/j.jsurg.2020.02.022

Cited by 1 publication

(4 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Blanket definitions that consider everything critical except incisions and closure, 6 conversely, may limit safe opportunities for trainees to gain the independence essential for graduation into practice. 7,11 Ideally, the identification of critical portions would go hand-in-hand with the development of training-levelspecific competencies 8 to identify areas where residents might be ultimately expected to be independent. Goal "In some respects, closing is considered not all that important, however in plastics, and reconstruction with closure, which often times if very lengthy, can be critical because the goal of the operation is the cosmetic result."…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…As litigation may hinge on expectations of surgeon presence for particular portions of procedures, 4 clarity on these definitions may also have implications for malpractice risk exposure. 8 Although CMS and ACS guidance defer to surgeons' expert judgment in identifying "critical portion(s)" of a procedure, and despite the impact of its definition on practice, training, and litigation, little is known about what concepts surgeons apply when deciding what parts of a procedure are critical. The purpose of this study was to elucidate how surgeons actually conceptualize and operationalize "critical portion(s)" determinations in practice.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Working Definitions of “Critical Portions”

2022

View full text Add to dashboard Cite

Objective: Identify the considerations academic surgeons use when determining which portions of a procedure are "critical" and necessitate their presence. Background: Teaching physicians are required to be present for the "critical portion" of surgical procedures, but the definition of what constitutes a critical portion remains elusive. Current guidelines defer to surgeons' expert judgment in identifying critical portion(s) of a procedure; little is known about what concepts surgeons apply when deciding what parts of a procedure are critical. Methods: Qualitative analysis of interviews with 51 practicing surgeons from a range of specialties regarding their working definition of critical portions. Results: Surgeons identified 4 common themes that they use in practice to define the critical portions of procedures: portions that require their firsthand observation of events, those involving challenging anatomy or structures that cannot be repaired if injured, and portions where an error would result in severe consequences for the patient. Surgeons also recognized contextual factors regarding the patient, trainee, surgeon, and team that might alter determinations for individual cases. Conclusions: Although critical portion definitions are largely treated as subjective, surgeons across multiple specialties identified consistent themes defining "critical portions'', suggesting that setting a minimum standard for criticality is feasible for specific procedures. Surgeons also recognized contextual factors that support the need for case-specific judgement beyond minimum standard. This framework of procedure features and contextual factors may be used as a guide for surgeons making day-to-day decisions and in future work to formally define critical portions for a given procedure.

show abstract

Section: Discussionmentioning

confidence: 99%